Healthcare Provider Details

I. General information

NPI: 1295729986
Provider Name (Legal Business Name): JAVIER LOPEZ DE ARCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3074 DYER BLVD
KISSIMMEE FL
34741
US

IV. Provider business mailing address

3074 DYER BLVD
KISSIMMEE FL
34741-7839
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-3011
  • Fax: 321-203-4627
Mailing address:
  • Phone: 407-635-3011
  • Fax: 321-203-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME95848
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 95848
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA76864
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14082
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: